EC Paediatrics

The COVID pandemic in 2020 introduced a series of considerations in airway management to minimize anesthesiologists exposure to the virus. Asymptomatic patients shed viruses and are infectious. It might be thought that the attitude of anesthesiologists would have changed when exposed to any undiagnosed pathogen. The objective of this study is to verify if there are differences in airway manipulation between the years 2018 and 2021.

This is a retrospective observational study. All patients under 16 years of age who underwent surgery at Vall d'Hebron University Hospital (Barcelona, Spain) in 2018 and 2021 were included. Means were represented as 95% confidence intervals (CI), categorical variables were represented as percentages. 5522 patients were included, 3435 in 2018 and 2087 in 2021. Following percentages in procedures (2018 vs 2021): Without instrument: 8.24 vs 15.33; Laryngeal mask: 41.33 vs 30.87; Direct laryngoscopy: 42.75 vs 50.65; Video laryngoscope: 1.35 vs 1.75; Fiberoptic bronchoscope: 0.12 vs 0.29; Intubation or tracheostomy upon arrival in the operating room: 6.19 vs 1.07.

Among the data collected, the increase in techniques without instrumentation of the airway (sedation in spontaneous breathing or with a face mask) and the maintenance in the percentages of use of video laryngoscopes stand out. In both cases, the possibility of spreading aerosols with contagious particles (RSV, influenza, SARS-CoV-2...) increases in all pediatric patients.

Keywords: Airway Management; Respiratory Aerosols and Droplets; Anesthesia, General; Infectious Disease Transmission; Patient-to-Professional

1. Orser BA. “Recommendations for Endotracheal Intubation of COVID-19 Patients”. Anesthesia and Analgesia 130 (2020): 1109-1110.
2. Matava CT., et al. “Pediatric Airway Management in COVID-19 Patients: Consensus Guidelines from the Society for Pediatric Anesthesia’s Pediatric Difficult Intubation Collaborative and the Canadian Pediatric Anesthesia Society”. Anesthesia and Analgesia 131 (2020): 61-73.
3. Hall D., et al. “Videolaryngoscopy increases ‘mouth-to-mouth’ distance compared with direct laryngoscopy” (2020).